DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM

Winter 2013

Nicotinic - skeletal Muscarinic - organ 4/22/2014

Winter 2013

4/22/2014

Peripheral Nervous System

Somatic: Voluntary
Innervates skeletal muscles Controlled through conscious thought

Neurotransmitter

Acetylcholine

Winter 2013

4/22/2014

Autonomic Nervous System

Autonomic

or visceral division not controlled by conscious

Controls Blood pressure Heart rate Gastrointestinal activity Glandular secretions

Winter 2013

4/22/2014

SUBDIVISIONS OF THE AUTONOMIC NERVOUS SYSTEM

Sympathetic nervous system

Fight or Flight Useful in highly stressful or emergency situations

Maintains homeostasis Works in opposition of the Sympathetic nervous system Rest and Digest

Parasympathetic nervous system

Winter 2013

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VOCABULARY SYNONYMOUS TERMS

SYMPATHETIC

AKA ADRENERGIC SYMPATHOMEMETIC

MIMICS THE SYMPATHETIC SYSTEM

PARASYMPATHETIC

AKA CHOLINERGIC PARASYMPATHOMEMETIC

MIMICS THE PARASYMPATHETIC NERVOUS SYSTEM

Winter 2013

4/22/2014

Adrenergic/Sympathetic
NEUROTRANSMITTERS

(neurohormones)

CATECHOLAMINES

Epinephrine (prototype) secreted by Adrenal gland, direct response at nerve ending Norepinephrine secreted by Adrenal gland. Stored in the axon, direct response at the nerve ending
ALPHA 1 ALPHA 2 BETA 1 BETA 2

RECEPTORS / RECEPTOR SITES

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Winter 2013

4/22/2014

RECEPTOR Responses to Stimulation

ALPHA I

(located on the target cells) Constriction Dilation Ejaculation Contraction Constriction

Blood vessels Pupils Penis Uterus Sphincters

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Alpha-1 Adrenergic drugs

Isuprel (isoproterenol)

Used for shock

Adrenalin (epinephrine)

Cardiac arrest Anaphylactic shock

Nasal decongestants (phenylephrine Neo-Synephrine)

Pseudoephedrine (Sudafed)
Winter 2013 4/22/2014

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RECEPTOR Responses to Stimulation

ALPHA 2 (located on presynaptic terminal) Control the release of norepinephrine and provide the negative feedback inhibition.

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Winter 2013

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ALPHA 2 Adrenergic Drugs

CLONIDINE (Catepres) Decrease blood pressure Management of Opioid withdrawal METHYLDOPA Decrease blood pressure, especially use din pregnant lady to decrease BP.

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Winter 2013

4/22/2014

RECEPTOR Responses to Stimulation

DOPAMINE RECEPTORS

Located in various tissues and organs Cause dilation of renal, mesenteric, coronary and cerebral arteries D1, D2, D3, D4

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Winter 2013

4/22/2014

Adrenergic drugs (Alpha 1)

ADVERSE EFFECTS V. THERAPEUTIC EFFECTS

Increased HR (tachycardia) Increased Blood pressure Decreased Gastric motilityconstipation Restlessness, irritability, anxiety, pallor Increased Alertness

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Winter 2013

4/22/2014

Adrenergic blocking drugs

Alpha and BETA blocking drugs

Uses (Beta1 receptors are located primarily on cardiac tissues - cardioselective)

Cardiac dysrhythmias Angina Hypertension Congestive heart failure Prostate hypertrophy (alpha blocker)

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Winter 2013

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Winter 2013

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Adrenergic (beta-1) blocking drugs

Beta-adrenergic blocking drugs(A-M are selective, From N-Z are non-selective ) Propranolol (Inderal)B1, B2 Nadolol (Corgard).B1, B2 Atenolol (Tenormin).B1 MetoprololB1 Timolol (Timoptic).B1, B2 Labetalol.Alpha and Beta

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ADRENERGIC BLOCKING DRUGS

Adverse reactions
Drowsiness, fatigue Bradycardia Hypotension Orthostatic hypotension Diarrhea

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Winter 2013

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Adrenergic blocking drugs

Nursing
Patient

considerations
teaching

Postural hypotension Signs and symptoms of Heart Failure Monitor blood pressure Taking their own pulse
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Parasympathetic (Cholinergic)Nervous System

NEUROTRANSMITTER (neurohormone)
Acetylcholine Produced and stored in nerve endings Acetylcholine (ACh) binds to Cholinergic receptor sites and causes a response

Stimulation results in rest and digest

Winter 2013 4/22/2014

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Acetylcholinesterase
(aka:cholinesterase)

Breaks down Acetylcholine or limits

response

Maintains the balance between acetylcholine and dopamine

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Winter 2013

4/22/2014

Uses only four for cholinergic drugs: Drugs that increase Acetylcholine in the Synapse

Glaucoma Reduce intraocular pressure Myasthenia gravis Disease caused by the lack of ACh at the synapse Relief of urinary retention Increase GI motility
Winter 2013 4/22/2014

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Indirect acting Cholinergic drugs

Neostigmine (Prostigmine)

(anticholinesterase) prototype
Primarily used to treat Myasthenia Gravis

Pyridostimine (Mestinon)
Myasthenia Gravis

Donepezil (Aricept)
Works in the CNS to inhibit synthesis of Acetylcholinesterase

Used to treat Alzheimers disease

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Winter 2013

4/22/2014

Cholinergic drugs

Direct acting Cholinergic drugs

Directly stimulates the nerve ending to secrete acetylcholine Bethanechol (Urecholine)

Used to treat urinary retention

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Winter 2013

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ADVERSE REACTIONS

CHOLINERGIC DRUGS

Bradycardia Hypotension Headache, dizziness Increased secretions Abdominal cramping Increased respiratory secretions and possibly bronchospasms

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Anticholinergic Medication

Competitive antagonists Compete with ACh Inhibit nerve transmission Sites of action All systems except musculo-skeletal

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Winter 2013

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Anticholinergic Medication

EXAMPLES Bentyl (dicyclomine HCL)

Antispasmotic used to decrease intestinal cramping in IBS

Atropine (Prototype) Acetylcholine antagonist Antidysrhythmic Antispasmotic Antisecretory

Winter 2013 4/22/2014

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Anticholinergic Medication

USES

Dry oral secretions Increase heart rate Treat ureteral colic Decrease GI motility Parkinsons disease Decrease upper respiratory secretions

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Winter 2013

4/22/2014

Urinary antispasmodics AKA anticholinergics

OXYBUTYNIN (DITROPAN)

Synthetic antimuscarinic INCREASES BLADDER CAPACITY DECREASES FREQUENCY OF VOIDING

TOLTERODINE (DETROL, DETROL LA)

Synthetic antimuscarinic DELAYS THE URGE TO VOID INHIBITS BLADDER CONTRACTIONS

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Winter 2013

4/22/2014

Anticholinergic Medication

Adverse reactions / Side effects

Dry mouth Blurred vision Photophobia Urinary retention Constipation Tachycardia Drowsiness

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Winter 2013

4/22/2014

Nursing Interventions

Monitor for signs of anticholinergic crisis Report changes in heart rate, blood pressure, or development of dysrhythmias Provide comfort measures for dryness of mucous membranes Minimize exposure to heat or cold or strenuous exercise Monitor I&O Monitor patient for abdominal distension, and auscultate for bowel sounds

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Winter 2013

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Anticholinergic Crisis

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